How Effective Are Hyaluronic Acid Injections In Remedying Chronic Knee Pain
Maybe your knee pain is worse when you wake up in the morning and are just starting to move around for the day. Or perhaps, by the end of the day, your knees are screaming for relief. Whatever your experience with knee pain, we know you want effective relief now.
Our anesthesiologist and pain management expert Syed Nasir, MD, here at Skilled Pain Care Clinic, PA, in Houston and Katy, Texas, offers an expert diagnosis of the many conditions and injuries that can cause knee pain. He creates personalized treatment plans to reduce your pain quickly and heal the underlying condition for long-term relief.
One of the many treatments available are hyaluronic acid injections, but are they useful for all types of knee pain?
Bone Marrow Aspirate Concentrate Or Bone Marrow Concentrate Type Stem Cell Therapy
Using stem cells taken from a patients bone marrow is becoming a therapy of interest due to the potential of these mesenchymal stem cells to differentiate into other types of cells such as bone and cartilage. This is not a new revolutionary treatment, this treatment has been studied and applied for many years. It is a difficult treatment for some doctors to give. You do need experience in all aspects of the treatment to give the patient the best chance at achieving their healing goals.
Bone Marrow is the liquid spongy-type tissue found in the hallow of bones. It is primarily a fatty tissue that houses stem cells that are responsible for the formation of other cells. These mesenchymal stem cells , also called marrow stromal cells, can differentiate into a variety of cell types including osteoblasts , chondrocytes , myocytes , adipocytes , fibroblasts and others when reintroduced into the body by injection. Bone marrow also contains hematopoietic stem cells that give rise to the white and red blood cells and platelets.
Clinical Studies Of Cross
Clinical studies have been conducted using cross-linked hylan in the treatment of knee osteoarthritis . A summary of four clinical trials performed in Germany using cross-linked hylan16 demonstrated excellent results in 71 percent of hylan-treated patients, compared with 29 percent of placebo-treated patients. After six months, 53 percent of hylan-treated patients still reported excellent pain relief, compared with 22 percent of the placebo-treated patients. In a double-blind, randomized placebo-controlled trial using hylan,17 it was found that 39 to 71 percent of hylan-treated patients were symptom free at 26 weeks compared with 13 to 45 percent of placebo-treated patients. Another study18 compared intra-articular hylan with NSAID therapy in a randomized blinded trial. Hylan was found to be as effective as NSAID therapy at 12 weeks and was superior to NSAID therapy at 26 weeks.
Recent Prospective, Randomized, Controlled Trials of Hylan G-F 20
Recent Prospective, Randomized, Controlled Trials of Hylan G-F 20
In addition, findings from a clinical practice19 showed that 80 percent of 458 knees injected with hylan had a positive response, and the average duration of efficacy was 8.2 months.
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Other Injections: Hyaluronic Acid Botox And More
Some people have used other types of injections for OA of the knee.
However, experts from the American College of Rheumatology and the Arthritis Foundation dont currently recommend using these, as theres not enough evidence that they work.
Examples of other types of injections include:
- hyaluronic acid injections, also known as viscosupplementation
You may not know exactly what type of injection youre receiving or what the effect might be.
Always discuss the pros and cons of any treatment with your doctor before starting, so that you can make an informed decision.
Is Prp Controversial Yes Is It Effective Also Yes
When it works. Below are many citations and references showing the effectiveness of PRP.
Lets start with the most recent research of the effectiveness of PRP for knee osteoarthritis.
- While an October 2020 study in The Journal of International Medical Research still acknowledges that the clinical efficacy of platelet-rich plasma in the treatment of osteoarthritis remains controversial, their examination of five clinical trials including 320 patients found: intra-articular injection of PRP is an effective treatment for osteoarthritis that can reduce post-operative pain, improve locomotor function, and increase patient satisfaction.
- This is a June 2020 study from the journal Clinical Rheumatology, Here researchers suggested that Intra-articular PRP injection provided better effects than other injections for osteoarthritis patients, especially in knee osteoarthritis patients, in terms of pain reduction and function improvement at short-term follow-up. .
- In a study published in the American medical journal Arthroscopy, medical university researchers suggested that PRP injections were more effective in the treatment of knee osteoarthritis, in terms of pain relief and self-reported function improvement at three, six, and twelve months follow-up, compared with other injection treatments. We are going to show the comparative research below.
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Knee Patients Spending Millions On Wasted Treatments Study Finds
Wasted treatments for knee pain have racked up millions of dollars in medical bills, researchers reported Tuesday.
Patients who had knee replacements went through treatments such as injections that did not help, that are not recommended, and that accounted for a third of their total medical bills, the researchers found.
Where Are Hyaluronic Acid Shots Given Do They Hurt
If you are going to get hyaluronic acid injections, the actual process is fairly simple. They are directly injected into the affected knee joint, specifically within the synovial fluid that bathes the joint, Dr. Miller says. Like any injection, it may seem more painful to some people than others, but there should not be a lot of pain since a sharp needle is used and the joint may be numbed first with a local anesthetic.
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What Is Hyaluronic Acid And What Does It Do
Hyaluronic acid, also known as hyaluronan, is a gel-like substance naturally present in the synovial fluid that lubricates your joints. Because arthritis patients lose hyaluronic acid as their joint wears away, the theory goes that replacing it with a process called viscosupplementation would make using the joint less painful. The injections are FDA-approved for knee osteoarthritis.
Its mechanism of action is not fully known, but is thought to at least temporarily increase the viscosity, or thickness, of the fluid that surrounds the joint it is injected into, says Donald Miller, PharmD, a professor at the School of Pharmacy at North Dakota State University. This may reduce pain and make joint movement easier.
You can think of it like WD-40 for your joints.
Caring Medical Research Case Studies
Our research team has published research on patient outcomes and case studies using bone marrow aspirate. Here is a sample of those outcomes. Again, we must remind you that this treatment does not work for everyone. Unfortunately, if you are reading this article you are probably very attuned to medical treatments that do not work.
In the medical journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, our Caring Medical research team published our findings in seven patients. The patients who were treated for knee pain are featured below:
Patient case Knee pain: A 69-year-old man
A 69-year-old male came into our office with pain in both knees, with his right knee significantly more painful. Pain resulted in frequent sleep interruption and limitation of exercise.
The patient had received prolotherapy at another office in the previous two years but felt that the treatment has reached its maximum ability to heal.
The patient was diagnosed with osteoarthritis and received five bone marrow/dextrose treatments in each knee at two-month intervals.
- Two months after the final treatment, the patient reported that he was completely free of pain or stiffness in both knees, had regained full range of motion, no longer suffered sleep interruption, and was no longer limited in exercise or daily life activities.
Patient case Knee pain A 56-year-old woman
The patient received bone marrow/dextrose treatments for six visits with 810 week intervals.
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Corticosteroid Knee Injections Provided No Significant Pain Relief After Two Years Researchers Say: Do Not Give Cortisone For Knee Osteoarthritis
In 2017, doctors from Tufts Medical Center in Boston asked, What are the effects of intra-articular injection of 40 mg of triamcinolone acetonide every 3 months on the progression of cartilage loss and knee pain in patients with osteoarthritis? Writing in the Journal of the American Medical Association, they published their answer:
Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.
Summary And Contact Us Can We Help You
We hope you found this article informative and it helped answer many of the questions you may have surrounding your knee problems and knee instability. If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff
Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C
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Your Insurance May Or May Not Cover Hyaluronic Acid Injections
The FDA has approved hyaluronic acid injections for osteoarthritis of the knee onlynot for OA that affects any other joints.
In part because the AAOS does not recommend hyaluronic acid injections for knee OA, there’s a strong possibility your insurance company will not cover it. If not, it’s important to know the procedure can be quite expensive: A course of three injections of Synvisc, for example, can cost as much as $1,600.
Medicare will cover HA injections for the knee, but you’ll likely have to provide documentation or X-ray evidence to prove it’s needed first. Both Medicare and private insurance typically will approve hyaluronic acid injections no more often than every six months.
What Happens During A Hyaluronic Acid Injection
Here at Skilled Pain Clinic, Dr. Nasir begins with a thorough consultation and exam to identify the cause of your knee pain. He needs to understand the cause of your pain in order to prescribe the most effective treatment. If you have osteoarthritis, and Dr. Nasir thinks hyaluronic acid injections will relieve your pain, he can provide hyaluronic acid injections during a brief visit.
When you have the injection, Dr. Nasir cleans the skin on your knee and may inject a local anesthetic. If you have severe swelling, he may perform a joint aspiration to extract some of the excess fluid. Then, using an X-ray to guide the needle, he injects the hyaluronic acid into your knee.
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Study: A Comparison Between Prolotherapy Botox Physical Therapy And Hyaluronic Acid Injections
Here we have a September 2020 study published in the International Journal of Rehabilitation Research. In it, researchers compared the effectiveness of four treatments in the management of knee osteoarthritis.
- In total, 120 patients with knee osteoarthritis, all over the age of 50 years of age were randomly allocated to four groups.
- The test results were based on pain and functional scoring systems.
- Exercise recommendations were prescribed daily for all participants throughout the study.
- For physical therapy , participants received superficial heat, transcutaneous electrical nerve stimulation, and pulsed ultrasound.
- Botox: Researchers administered a single intra-articular injection of botulinum neurotoxin type A
- Hyaluronic acid: Researchers administered three injections of hyaluronic acid
- Prolotherapy: Researchers administered 20% dextrose to patients in the corresponding groups.
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What Are The Benefits And Risks
While it may take several injections before you see results, once you do get some relief from pain and stiffness, it can last for up to six months. Some people may even experience relief for up to a year. However, that pain and stiffness will recur at some point.
The side effects of HA injections are fewer than those associated with other treatments, such as corticosteroid injections. According to Scott Rodeo, HA is safe, well tolerated and does not have as many adverse effects as steroid injections do.
After an injection, you may experience mild pain, swelling and stiffness in and around the joint.
Am I A Good Candidate
Like any treatment for knee arthritis, some individuals respond better than others. Approximately 50% of patients have a noticeable improvement in their knee function and pain after receiving gel injections3. Much research has been done to understand the characteristics of people who consistently respond well to gel injections for knee arthritis4.
If you are considering getting gel injections for knee arthritis, take a look at the candidacy checklist. This tool is based on a 2011 study4 reviewing past scientific research on the effect of hyaluronic injections on those with knee osteoarthritis. The better candidate you are the more likely you are to have a positive experience. If you want to learn more or feel like this treatment could be for you, discuss your specific situation with your doctor.
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How Does Prolotherapy Work In Your Knees
In this section, we will discuss Prolotherapy knee osteoarthritis injections. Prolotherapy is a remarkable treatment in its simplicity. The treatment can help many patients avoid joint replacement. But it is not a miracle cure. The research and evidence for how Prolotherapy may help you are presented here and intermingled with our own 27+ years of empirical observation of patient benefit.
In 2016, our Caring Medical research team published our study, A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain in the journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders. In this review, we examined the research in the use of dextrose Prolotherapy for the treatment of tendinopathies, knee and finger joint osteoarthritis, and spinal/pelvic pain due to ligament dysfunction. In our section on knee pain, we referred to a study by Dr. Fariba Eslamian and Dr. Bahman Amouzandeh of Tabriz University of Medical Sciences. This is what they published in the journal Therapeutic Advances in Musculoskeletal Disease.
Prolotherapy has been reported as a useful method in the treatment of chronic musculoskeletal and joint diseases. It is proposed that Prolotherapy causes mild inflammation and cell stress in the weakened ligament or tendon area, releases cytokines and growth factors and induces a new healing cascade in that area, which leads to activation of fibroblasts, generation of collagen precursors, and strengthening of the connective tissue.
Although Surgery And Cortisone Are Common Randomized Trials Have Failed To Produce Evidence For Their Effectiveness Or How Much They Do Work
Moving forward on that research, a February 2020 review study with the title Medical Reversals in Family Practice: A Review, published in the journal Current Therapeutic Research, Clinical and Experimental offered these points:
- Despite inconsistent recommendations for more invasive treatments, hundreds of thousands in the United States are treated with corticosteroid injections and surgery. Although these practices are common, randomized trials have failed to produce evidence for their effectiveness.
- Because corticosteroids have an anti-inflammatory effect and because osteoarthritis is an inflammatory condition, intra-articular corticosteroids have has been used for several decades, and as many as 95% of rheumatologists use them for osteoarthritis however, in a randomized trial of patients with symptomatic knee osteoarthritis, in which 140 patients were treated with an injection of either triamcinolone or saline every 12 weeks for 2 years, there were no differences in pain between patients treated with triamcinolone or saline. Further, patients assigned to the triamcinolone treatment had a greater loss in cartilage thickness. .
- Many patients are likely better off with a less-is-more approach of low-impact physical activity and strength training exercises than cortisone or surgery.
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Research Comparing Prp Bone Marrow And Adipose
A July 2020 study published in the journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, compared platelet-rich plasma , bone marrow aspirate concentrate, and adipose-derived mesenchymal stem cell injections in the treatment of osteoarthritis of the knee using functional scores.
- Methods: A total of 89 patients with painful knee osteoarthritis were included in this study.
- Patients were assigned to one of the 3 treatments according to the severity of osteoarthritis as indicated by symptoms and radiography to PRP , bone marrow aspirate concentrate , or adipose-derived MSC .
- Clinical assessment was performed using standard scoring systems, Surveys were completed at preoperative, and at 90, 180, and 265 days post-treatment.
Results: They all worked well.
- In a general statement, the PRP worked just as well in stage 1 knee osteoarthritis patients as the bone marrow aspirate worked in the stage 2 knee osteoarthritis patients and the adipose-derived stem cells worked for the stage 3 knee osteoarthritis patients. To quote the researchers: Our findings support previous reports and encourage further research on the use of these cost-effective treatments for osteoarthritis of the knee.
This is also a validation of our policy of not going straight to stem cell therapy in some of our patients. PRP or Prolotherapy, which is discussed below can provide equally good results without the added expense.